Effect of Left Atrial Size and Volume Reduction on Pulmonary Vein Isolation Efficacy in Patients With Persistent and Longstanding Persistent Atrial Fibrillation: Subset Analysis From the aMAZE Trial.
Document Type
Article
Publication Title
Circulation. Arrhythmia and electrophysiology
Abstract
BACKGROUND: Large left atrial volume (LAV) is a strong predictor of advanced left atrial substrate and is associated with less successful outcomes following pulmonary vein isolation (PVI) alone. Prespecified variables of the aMAZE trial were evaluated to access for the impact of LAV and left atrial appendage ligation on atrial fibrillation (AF) outcomes.
METHODS: The aMAZE trial (REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02513797) was a multicenter, randomized-controlled study evaluating the effects of LAV on freedom from atrial arrhythmias (AA) following PVI-only compared with LARIAT and PVI (LARIAT+PVI). In total, 610 drug-refractory patients with nonparoxysmal AF were randomized 2:1 to LARIAT versus PVI alone. Freedom from AA was assessed 12 months postprocedure. LAV was independently assessed by a core laboratory from cardiac computed tomography performed before ablation.
RESULTS: There were 404 patients in the LARIAT+PVI group and 206 in the PVI-only group. Logistic regression performed within each subgroup for primary effectiveness with LAV demonstrated that the recurrence of AA after PVI was directly related to increasing LAV. Freedom from recurrence of AA in the LARIAT+PVI arm was independent and preserved irrespective of LAV. Similar results were seen with LAV index. A tercile analysis of early persistent AF (perAF) patients (AF >7 days and < 6 months) and LARIAT+PVI in the highest (>148 cm
CONCLUSIONS: The correlation of LAV with PVI effectiveness in this study demonstrates that AA recurrence after PVI alone is directly related to increasing LAV. Freedom from AA after left atrial appendage ligation in addition to PVI is independent of increasing LAV, and left atrial appendage ligation may therefore provide an adjunctive benefit in patients with nonparoxysmal AF and enlarged LAV.
First Page
014755
Last Page
014755
DOI
10.1161/CIRCEP.125.014755
Publication Date
7-28-2026
Recommended Citation
Lakkireddy DR, Wilber DJ, Mittal S, Tschopp D, Ellis CR, Rasekh A, Hounshell T, Hoyt R, Evonich R, Chandhok S, Berger RD, Horton R, Hoskins MH, Calkins H, Yakubov SJ, Khalique O, Pulerwitz T, Badhwar N, Dewland T, Weiner S, Valsaiwala S, Katapadi A, Simons P, Walker P, Ndilkintum N, DiBiase L, Natale A, Lee RJ; aMAZE Investigators. Effect of Left Atrial Size and Volume Reduction on Pulmonary Vein Isolation Efficacy in Patients With Persistent and Longstanding Persistent Atrial Fibrillation: Subset Analysis From the aMAZE Trial. Circ Arrhythm Electrophysiol. 2026 Jul 28:e014755. doi: 10.1161/CIRCEP.125.014755. Epub ahead of print. PMID: 42517227.